Pandey P R
Nepal Eye Hospital, Tripureshwor, Kathmandu, Nepal.
Kathmandu Univ Med J (KUMJ). 2006 Jan-Mar;4(1):65-9.
This is a study profile of the patients undergoing destructive surgery in Nepal Eye Hospital over a period of 2 years (2001-2003). The rationale of the study was to know the incidence and causes for destructive surgery (enucleation/evisceration) and the measures to prevent them. Patients admitted in the ward from emergency and outpatients departments for the purpose of enucleation and evisceration were taken into this study. Their visual acuity, slit-lamp examinations, fundus evaluation were done. Most of the patients had no perception of light with painful blind eyes, panophthalmitis, endophthalmitis, staphylomas, crush injuries and malignancies. After a decision made by the surgeons in the round, a full consent was taken for the operation. Evisceration was done for cases with history of ocular infections and the rest were enucleated. Destructive operation was done for (a) saving the other eye, (b) life saving, (c) painful condition and disfigurement. The incidence of destructive surgery in Nepal Eye Hospital was 1.40%. male : female ratio was 1.41:1. The causes for destructive surgery were panophthalmitis (31.71%), painful blind eye (21.95%), endophthalmitis (14.63%), staphyloma (14.63%), retinoblastoma (12.20%) and crush injuries (4.88%). Number of evisceration (73.17%) was higher than enucleation (26.83%) as most of the cases were sequele of corneal ulcer. Enucleation was mostly seen in children and evisceration in adults. Lastly, the incidences of destructive surgery would be minimized by (a) Prompt treatment of corneal ulcers for reducing panophthalmitis (b) pre, intra, and post operative care in intra ocular surgery for reducing endophthalmitis, and (c) genetic counselling (pre marital) for reducing childhood malignancies. Decision for destructive surgery should be a team work rather than a single surgeon's opinion. It should be done under general anaesthesia or retrobulbar block. Precaution must be taken to prevent the appalling tragedy of enucleating the wrong eye by marking above on the eye to be operated or EUA prior to surgery. Last but not the least, there should be fitting of a prosthesis for cosmesis, psychological support and careful follow-up of the healthy eye.
这是一项关于尼泊尔眼科医院在2年期间（2001 - 2003年）接受眼球摘除术患者的研究概况。该研究的目的是了解眼球摘除术（眼球摘除/眼内容剜出术）的发生率、原因以及预防措施。本研究纳入了因眼球摘除或眼内容剜出术从急诊科和门诊部收治入院的患者。对他们进行了视力、裂隙灯检查和眼底评估。大多数患者患眼疼痛且无光感，存在全眼球炎、眼内炎、葡萄肿、挤压伤和恶性肿瘤。经外科医生会诊决定后，患者签署了手术知情同意书。对于有眼部感染病史的患者行眼内容剜出术，其余患者行眼球摘除术。进行眼球摘除术的目的是：（a）挽救另一只眼；（b）挽救生命；（c）缓解疼痛和改善容貌。尼泊尔眼科医院眼球摘除术的发生率为1.40%。男女比例为1.41:1。眼球摘除术的原因包括全眼球炎（31.71%）、疼痛性盲眼（21.95%）、眼内炎（14.63%）、葡萄肿（14.63%）、视网膜母细胞瘤（12.20%）和挤压伤（4.88%）。眼内容剜出术的数量（73.17%）高于眼球摘除术（26.83%），因为大多数病例是角膜溃疡的后遗症。眼球摘除术多见于儿童，而眼内容剜出术多见于成年人。最后，可通过以下措施将眼球摘除术的发生率降至最低：（a）及时治疗角膜溃疡以减少全眼球炎；（b）在眼内手术中进行术前、术中和术后护理以减少眼内炎；（c）进行遗传咨询（婚前）以减少儿童恶性肿瘤。眼球摘除术的决策应是团队协作，而非单一外科医生的意见。手术应在全身麻醉或球后阻滞下进行。术前必须采取预防措施，通过在拟手术眼上方标记或在手术前行眼球摘除术前评估来防止摘除错误眼球这一可怕悲剧的发生。最后但同样重要的是，应安装义眼以改善容貌，给予心理支持，并对健眼进行仔细随访。
